According to the US Celiac Disease Foundation, celiac disease (CD) affects about 1 in 100 people on a global scale. It is a gastroenterological autoimmune disease that stimulates the body to recognize gluten as a threat, triggering strong immune response (inflammation).
As this health condition affects the gastrointestinal tract, many people believe that the intake of probiotics (either in the form of food or as supplements) may improve the symptoms and overall condition of celiac disease patients. But is that really true?
This article will guide you through the characteristics of celiac disease and how the intake of probiotics can affect the severity of its symptoms.
Let’s get started!
What is celiac disease?
Celiac disease is an autoimmune disease that is also well known as gluten intolerance.
This serious health condition is characterized by abnormal immune response to gluten (a type of protein found in some grains), which may cause intense symptoms, damage the small intestine, and limit the proper absorption of nutrients in the body.
Evidence suggests that, in the long run, untreated celiac disease can lead to severe health problems like anemia, osteoporosis, infertility, vitamin and mineral deficiencies, nervous system damage, pancreatic impairment, intestinal cancer, and others. It may also trigger the development of other autoimmune conditions like multiple sclerosis (MS) and type 1 diabetes. [1]
What are the symptoms of celiac disease in adults?
Even though celiac disease is not a rare health condition, the US Celiac Disease Foundation shares that 83% of the patients remain undiagnosed or misdiagnosed due to the big diversity of symptoms (or the lack of those). [2]
In that sense, the symptoms may vary between patients, but some of the repeating, general signs of celiac disease include [3]:
- Abdominal pain
- Bloating
- Diarrhea or constipation
- Lack of appetite
- Acid reflux
- Anemia
- Fatigue
- Nerve damage
- Infertility
- Skin rash
- Coordination disorders
With more than 250 different symptoms, celiac disease can decrease the life quality of patients and impose related health risks. That is why it’s so important to be educated about this health condition, get diagnosed early, and start timely treatment.
Do Probiotics Help Celiac Disease?
The usual treatment for celiac disease focuses on a gluten-free diet that excludes all the food sources of gluten: natural and artificial. Keep in mind that gluten-free diet is the first choice of treatment in celiac disease which can improve the overall health condition, prevent further damage, and manage their symptoms. The problem is that a lot of patients can’t manage to follow a strictly gluten-free diet and sometimes, these patients have a lot of “small” residual symptoms. [4]
That being said, it turns out that about 20% of celiac disease patients don’t actually respond to gluten-free diets, because of different reasons, like not following the gluten free diet completely, more severe disease, overlap with irritable bowel syndrome (IBS), small bacterial overgrowth (SIBO) and microscopic colitis (MC). [5] But if the consumption of gluten is not the main issue, then what is?
A 2014 medical paper published in the American Society for Microbiology Journal suggests that gut flora (microbiome) may play a major role in the development and control of celiac disease, as the intestinal microbiota of celiac disease patients differs from the microbiota of healthy individuals.
Or in other words, the abundance and balance of gut bacteria differ in people with and without celiac disease Sometimes, if patient with celiac disease follows gluten-free diet (GFD), but has SIBO, IBS or MC (see abbreviations above) , have to have to perform additional diagnostic test or to have additional treatment to GFD. [6]
In that sense, a 2018 scientific study suggested that, after evaluation of the gut microbiome, some microbiological diagnostic test, or discovering SIBO or IBS, patients with celiac disease may benefit from probiotics intake (supporting the abundance of bifidobacteria in the intestines).
This probiotics intake has to be strictly prescribed by a gastroenterologist, after good individual evaluation of the celiac disease patient. In many cases, when SIBO is found, the celiac disease patient even has to take antibiotics, then probiotics to prevent Cl diff. (type of bacterial infection) or other complications.
Then, they have to make serum test anti-tTG (IgA+IgG) and anti-DGP (they are with high sensitivity and specificity ~ 91%). Second, the patient has to not start a gluten free diet, before final diagnosis of CD.
Third, have to perform upper gastroscopy with duodenal biopsy for histology from the duodenum. Fourth, after all the test shows that the patient has CD, then he can start GFD. If the patient doesn’t respond to the treatment they have to search for a lot of other reasons like IBS, SIBO and MC.
After that, he can try some probiotics (legally registered as a medical product) as a co-therapy to GFD. Remember, that probiotics can’t fix any of the problems of the patients with CD, if they don’t follow a strictly gluten free diet!
It’s important to keep in mind that there is a great difference in the efficiency of probiotic supplements (which you can buy without prescription) and probiotic medicines (that are registered as medical products).
That being said, there are a lot of studies with probiotics for celiac disease, but the most of the probiotics are not registered as a medical product, so when probiotics are prescribed, first have to be consulted with gastroenterologist and have to check of the probiotic have registered/reported clinical trials worldwide [7] [8]
There are a lot of studies that try to prove that intake of probiotics can positively affect celiac disease patients and improve their quality of life, but the most important focus is first to strictly follow gluten-free diet of the celiac disease patients, then try to make better diagnostic procedures for discovering the gut microbiome of the patient. After all these procedures, then the gastroenterologist can try to prescribe probiotics to CD patients!
Conclusion
Consulting your gastroenterologist or healthcare provider about a proper treatment plan for celiac disease is a crucial step in the management of this condition. As this health disorder may impose severe health risks, it’s important to avoid self-treatment and precisely follow the advice of your doctor.
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